Better Hearing Month; Pre-Menopause Symptoms; When Do Meds Expire; Celiac Sprue.

Happy (late) Memorial Day!  I hope you found time to enjoy yourself, but more importantly I hope you found time to thank those Americans who have fought to provide us with the freedoms we so enjoy.  And while you were contemplating these heroes, I hope you thought gratefully of the families of these soldiers, as they too have given so much to our country & thus deserve our heartfelt thanks as well! 

The following is the brief print version of the May 18, 2012 broadcast of Let's Talk Medical with Doctor Gigi

Better Hearing Month:

As you may know, an Audiologist is a healthcare professional who can diagnose & treat hearing & balance problems.  They usually possess a Master's degree or a Doctorate.  Unlike an Otolaryngologist (or Ear, Nose, & Throat surgeon), they cannot prescribe medications nor can they do surgery, but they can practice independent of physicians & do not need a doctor's order for their services.  My friend Susan Terry is an Audiologist in St. Petersburg, FL.  She owns Broadwater Hearing Care, Inc., & she works very hard to educate patients & physicians in regards to hearing issues.   May is Better Hearing Month, so she recently sent educational sheets which I found enlightening;  thus, I chose to share her information with the audience.

Hearing impairment affects 10% of the population & is the 3rd most common chronic health condition in the US.  Hearing loss increases with age, thus it affects 30-35% of people 65 or older, whereas 40-50% of people 75 or older will be affected.

The onset of hearing loss is insidious, gradually worsening over years, thus it is often not noticed by the patient himself, but more by his friends & family.  This is the reason so many people adamantly deny having a problem until they get tested & treated.

Hearing loss can lead to frustration, which in turn can lead to social isolation.  This is turn can lead to depression, so we must always consider hearing loss as a possible cause for depression, especially in the elderly.

For each 10 decibels of hearing lost, the risk of dementia increases about 20%.  Thus we must also consider hearing loss as a possible cause for dementia.

Diabetes & heart disease both increase the risk of hearing loss, likely due to vascular changes in the ear.

Every person over the age of 40 should have a baseline hearing test.  Remember that your risk is higher if you have diabetes or heart disease, so you might get the test earlier & every few years.  Quality of life is much better with early diagnosis & treatment, so don't make excuses, just get tested!

Pre-Menopausal Symptoms:

Menopause is the cessation of ovarian function, so it occurs when the ovaries "die" of old age (natural menopause) or when surgery removes them (surgical menopause).  The ovaries produce most of a woman's estrogen, progesterone, & testosterone, so with their death, women note many physical & emotional changes.  Most women go through natural menopause between the ages of 48 - 52.  By definition, a person is menopausal when she has gone 1 year without a menstrual period. 

For several years before full menopause, a woman will have pre-menopause.  This is a roller-coaster ride hormonally as the ovaries are "sputtering" before they die.  Some days they produce too many hormones, some days they produce too few, & some days they produce just the right amount.  As you can imagine, this is a hard time for many women as they don't know day to day how they are going to feel... physically or emotionally!  Unfortunately this period of pre-menopause can last 5 years

Pre-menopausal symptoms include: irregular periodshot flushespoor sleepfatiguemoodiness, & vaginal dryness.  Initially the periods get closer together... every 2-3 weeks.  Later they start to spread out, occuring every 2-3 months. Eventually the periods spread further & further apart & once there is no period for 1 year, we consider that full menopause. 

Hot flushes are common, so many people think they are synonymous with menopause, but they are not!  Anxiety can cause hot flushes, as can hyperthyroidism, certain cancers, or even excess caffeine.  Some anti-depressants cause hot flushes as well.  It is interesting to note that the heat associated with a hot flush can actually be felt by other people!  If someone touches you during an episode, they can likely feel the excess heat... so it is truly an increase in your temperature & not just in your mind!

Vaginal dryness is the true hallmark of menopause, as it is almost exclusively due to menopause when it occurs chronically!  It is not always an early symptom of menopause, but once it starts, it generally worsens.  In fact, without estrogen replacement, vaginal dryness often gets worse year after year, even after the other pre-menopausal symptoms have abated.

As for the moodiness, I suppose that if a man felt bad physically & emotionally, & if he couldn't sleep well & found sex to suddenly be uncomfortable, he would likely be very moody!  So ladies, we owe no one an apology!

When Do Meds Expire?:
Most medications are labeled with an expiration date that is 2 years after the date that the prescription bottle was filled.  But does that really mean that they are unsafe or in need of disposal once that date has passed?  First it is important to know that the medication is not likely toxic, but perhaps it has lost some of its potency.  So the real question is whether or not you can accept a bit less potency & still be safe.

If the medication is an antibiotic, I would recommend that you NOT take an expired version.  If the antibiotic does not work well you could end up with an untreated infection which could kill you.

On the other hand, if you try an old cough medicine, the worse thing that might happen is that you will continue to cough.  Certainly if that occurs, you would dispose of the expired med & purchase a new batch.  Similarly, if you take an old Valium, you might still feel anxious, but this would simply lead you to get to the pharmacy for a better supply.  Even an expired blood pressure pill is okay to try, as long as you follow your blood pressure's response... & get a non-expired version if the expired one doesn't control it properly.

If you can follow your body's response to a medication so you can properly judge it's effect, & if you can afford to have less than perfect control of your problem for a little while, then it is alright to try an expired med.  For the record though, I would seldom take one which is more than 2 years post expiration.  Also, regardless of the expiration date, if it looks or smells different, don't take it... kind of like milk!

Celiac Sprue:

Celiac sprue is a disease caused by an intolerance to gluten... which is a protein found in wheat, rye, & barley.  It is a hereditary disorder & runs in families.  Though it often becomes symptomatic during childhood, it can begin later in life.  The symptoms of sprue are many:  weakness, anorexia, diarrhea, weight loss, iron-deficiency anemia, oral ulcers, Vitamin D & C deficiencies, osteoporosis, reduced fertility, & rashes.  There is also an association between diabetes, autoimmune thyroid disease, & Down's syndrome, so if you are diagnosed with either of these diseases, you should have a work-up for sprue.

Recently this disease has gotten a lot of attention, & many people believe that they have it.  They often will simply change to a gluten-free diet to see if they feel better, then assume that they likely have the disease if the diet helps.  Unfortunately this often leaves them struggling with a miserable diet for the rest of their lives, as there is no treatment for sprue except to avoid gluten; yet a gluten-free diet is pretty restrictive & often expensive.

So I want to propose that if you think you have sprue, you need to see your doctor to have a work-up.  In this manner you will know for certain whether or not you MUST follow this diet.  The easiest test is a blood test called a tTG IgA... which stands for tissue transglutaminase immuneglobulin A.  You must know however that this test is measuring your body's immune response to gluten, so if you have been on a gluten-free diet, it will be negative!  Thus you should actually eat a lot of gluten for several weeks BEFORE you have the test drawn.  Also, since the test measures IgA, people who have IgA Deficiency will test negative.

To have proper evaluation you should eat a lot of gluten for several weeksthen have the tTG IgA test drawn. 
     If it is high, you have sprue
     If it is normal or low, you need another blood test... a Total IgA level.
          If it is normal, you do not have sprue.
          If it is low, you have IgA Deficiency... thus you cannot make IgA, even if you have sprue.
               You thus need further testing to evaluate for sprue, so you would need an upper endoscopy
               (= EGD) to get into your small bowel and obtain a biopsy.
                    If the biopsy is normal, you do not have sprue.
                    If the biopsy is abnormal & consistent with the inflamation caused by sprue, you have
                         sprue & are stuck with the gluten-free diet!

I hope this has been educational for you!  Don't forget you can catch the live show on Fridays on WTAN 1340-AM in the Tampa/St. Petersburg area, or you can use the computer to catch us live or on podcasts via  Please call or e-mail me with questions or comments:  (727)-441-3000, or toll-free (866)-TAN-1340, or

Until the next time, here's to our health!

Doctor Gigi